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General NPI Number Information
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NPI Number | 1508430885
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Entity Type | Individual
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Provider Name | ANGEL DIMITRINA GUTIERREZ BA, SLPA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 101 S AIRPARK RD
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4182
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Country | US
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Telephone | 928-639-2694
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 E CHAPARRAL DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4915
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Country | US
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Telephone | 928-202-7852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA13029
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License Number State | AZ
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